title: Low back pain in primary care: costs of care and prediction of future health care utilization.
abstract: METHODS
  Cost of illness study alongside a randomized controlled trial.
  
  
  OBJECTIVE
  To describe the costs of care for patients with low back pain (1) and to identify patient characteristics as predictors for high health care cost during a 1-year follow-up (2).
  
  
  BACKGROUND
  Low back pain (LBP) is one of the leading causes of high health care costs in industrialized countries (Life time prevalence, 70%). A lot of research has been done to improve primary health care and patients' prognosis. However, the cost of health care does not necessarily follow changes in patient outcomes.
  
  
  METHODS
  General practitioners (n = 126) recruited 1378 patients consulting for LBP. Sociodemographic data, pain characteristics, and LBP-related cost data were collected by interview at baseline and after 6 and 12 months. Costs were evaluated from the societal perspective. Predictors of high cost during the subsequent year were studied using logistic regression analysis.
  
  
  RESULTS
  Mean direct and indirect costs for LBP care are about twice as high for patients with chronic LBP compared to acutely ill patients. Indirect costs account for more than 52% to 54% of total costs. About 25% of direct costs refer to therapeutic procedures and hospital or rehabilitational care. Patients with high disability and limitations in daily living show a 2- to 5-fold change for subsequent high health care costs. Depression seems to be highly relevant for direct health care utilization.
  
  
  CONCLUSIONS
  Interventions designed to reduce high health care costs for LBP should focus on patients with severe LBP and depressive comorbidity. Our results add to the economic understanding of LBP care and may give guidance for future actions on health care improvement and cost reduction.
authors.affiliation: Department of General Practice, Preventive, and Rehabilitation Medicine, University of Marburg, Marburg, Germany. annette.becker@staff.uni-marburg.de
authors.forename: Annette
authors.initials: A
authors.lastname: Becker
authors.forename: Heiko
authors.initials: H
authors.lastname: Held
authors.forename: Marcus
authors.initials: M
authors.lastname: Redaelli
authors.forename: Konstantin
authors.initials: K
authors.lastname: Strauch
authors.forename: Jean F
authors.initials: JF
authors.lastname: Chenot
authors.forename: Corinna
authors.initials: C
authors.lastname: Leonhardt
authors.forename: Stefan
authors.initials: S
authors.lastname: Keller
authors.forename: Erika
authors.initials: E
authors.lastname: Baum
authors.forename: Michael
authors.initials: M
authors.lastname: Pfingsten
authors.forename: Jan
authors.initials: J
authors.lastname: Hildebrandt
authors.forename: Heinz-Dieter
authors.initials: HD
authors.lastname: Basler
authors.forename: Michael M
authors.initials: MM
authors.lastname: Kochen
authors.forename: Norbert
authors.initials: N
authors.lastname: Donner-Banzhoff
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D005544:Forecasting; D017048:Health Care Costs / Q000639:trends; D006801:Humans; D017116:Low Back Pain / Q000191:economics* / Q000523:psychology / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods; D010342:Patient Acceptance of Health Care; D011237:Predictive Value of Tests; D011320:Primary Health Care / Q000191:economics* / Q000706:statistics & numerical data / Q000639:trends; D055815:Young Adult